NPI |
1184775678 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
Entity Type Code |
2 |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Employer Identification Number EIN |
|
The city name in the location address of the provider being identified. |
Provider Organization Name Legal Business Name |
VISUAL EDGE, INC |
The State code in the location of the provider
being identified. |
Provider Other Organization Name |
PEARLE VISION |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Other Organization Name Type Code |
3 |
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional
name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other. |
Provider First Line Business Practice Location Address |
2825 W MAIN ST STE 5D |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Business Practice Location Address City Name |
BOZEMAN |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
MT |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Postal Code |
597183927 |
The code designating the provider’s gender if the provider is a person. |
Provider Business Practice Location Address Country Code If outside U S |
US |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Provider Business Practice Location Address Telephone Number |
4065874214 |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
Provider Business Practice Location Address Fax Number |
4065868738 |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
Provider Enumeration Date |
1/13/2007 |
|
Last Update Date |
8/22/2020 |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
Authorized Official Last Name |
ZWEBER |
|
Authorized Official First Name |
JOSEPH |
The first name of the authorized official. |
Authorized Official Title or Position |
CEO |
The title or position of the authorized official. |
Authorized Official Telephone Number |
9523455044 |
The 10-position telephone number of the authorized official. |
Healthcare Provider Taxonomy Code 1 |
156FX1800X |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Provider License Number 1 |
0145852 |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
Provider License Number State Code 1 |
MT |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Other Provider Identifier 1 |
0626900004 |
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
Other Provider Identifier Type Code 1 |
01 |
Code indicating the type of identifier currently
or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form. |
Other Provider Identifier State 1 |
MT |
|
Other Provider Identifier Issuer 1 |
MEDICARE DMERC REGION D |
|
Other Provider Identifier 2 |
0550901 |
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
Other Provider Identifier Type Code 2 |
05 |
Code indicating the type of identifier currently
or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form. |
Other Provider Identifier State 2 |
MT |
|
Is Organization Subpart |
N |
|
Authorized Official Name Prefix Text |
MR. |
|
Healthcare Provider Taxonomy Group 1 |
193400000X SINGLE SPECIALTY GROUP |
|